Advisee Form
Please complete the following form prior to your advisor meeting. If there are any questions or issues with completing this form, please email gannon.sungar@denverem.org for assistance.
Your Name *
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Advisor Name *
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CV *
Please upload a current version of your CV
Attach file
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Chart *
Please upload a DE-IDENTIFIED chart for review by your faculty advisor. This can be a chart from either Denver Health or UCH and should include your HPI, ROS, PE, and MDM. You may simply copy and paste the de-identified components of your chart into a word processing document.
Attach file
Drop files here
Please enter the number of evaluations of faculty that you have submitted since the beginning of the academic year (7/1/22)
Follow-Ups
Please acknowledge that you have completed and submitted 5 follow-ups
Procedure Log
Please acknowledge that your procedure log is up to date at https://mytipreport.org/ucdenver/emergency
Rosh Quizzes
Please acknowledge that you have completed all assigned Rosh quizzes. Assigned quizzes can be accessed at https://www.roshreview.com
Reflection 1 *
Reflect on your clinical practice, personal behaviors and interactions, and their impact on your colleagues and patients based on the feedback and performance data that you have received.
What are you doing well?
Reflection 2 *
What could you do better?
Reflection 3 *
What are your plans for future growth?
Reflection 4 *
Reflect on a time when your well-being was threatened by sleep dysfunction, "burnout", compassion fatigue, a difficult patient encounter, or personal stress. How did you respond to this threat? What went well and what could have gone better in your response? How would you teach others to respond?
Reflection 5 *
Do you have nonmedical/nonacademic goals that are important to you and achievable for the next year?
Additional Comments
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